Upper Airway Stimulation Response in Older Adults with Moderate to Severe Obstructive Sleep Apnea

Objective To evaluate the impact of age on safety, efficacy, and usage of upper airway stimulation (UAS). Study Design Multicenter observational study. Setting Thirteen US hospitals and 3 German hospitals. Subjects and Methods The ADHERE registry is a multicenter database enrolling patients undergoing UAS implantation from October 2016 to April 2018. Outcome measures included the Epworth Sleepiness Scale, apnea-hypopnea index (AHI), therapy usage, and complications. Data were segmented by age (<65 vs >= 65 years). Results Younger adults (n = 365) were a mean +/- SD 52.7 +/- 7.9 years old and 82% male, with a body mass index of 29.6 +/- 3.8. Older adults (n = 235) were 71.1 +/- 4.8 years old and 71% male, with a body mass index of 28.8 +/- 3.8. Baseline AHI was similar (younger, 36.2 +/- 15.9; older, 36.1 +/- 14.8). Both groups had lower AHI at 12 months versus baseline (P < .001), but the older group showed a greater reduction (7.6 +/- 6.9 vs 11.9 +/- 13.4, P = .01). The Epworth Sleepiness Scale score decreased from 12.3 +/- 5.4 to 7.1 +/- 4.8 (P < .001) among younger adults and from 10.7 +/- 5.7 to 6.3 +/- 4.4 (P < .001) among older adults. Usage was slightly higher among older adults (6.0 +/- 2.0 vs 5.4 +/- 2.1 hours/night, P = .02). Surgical time was similar between younger patients (2.4 +/- 0.7 hours) and older patients (2.3 +/- 0.7 hours, P = .40), with comparably low complications. Conclusion AHI reduction and therapy usage were found to be somewhat higher among patients aged >= 65 years who were treated with UAS. Surgical complications were low, in contrast to traditional sleep surgery.